Prazosin for Treating Noncombat Trauma Post-Traumatic Stress Disorder

Not Applicable

Terminated

Conditions: Sleep Initiation and Maintenance Disorders
Post-Traumatic Stress Disorder

Interventions: Drug: Placebo
Drug: Prazosin
Behavioral: Psychotherapy

Registration Number: NCT00183430

Lead Sponsor: Seattle Institute for Biomedical and Clinical Research

Brief Summary: This study will evaluate the effectiveness of prazosin in treating post-traumatic stress disorder caused by noncombat trauma in individuals taking selective serotonin reuptake inhibitors.

Detailed Description: Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event in which grave physical harm occurred or was threatened. People with PTSD have persistent frightening thoughts and memories of their past ordeal and often feel emotionally numb, especially with people to whom they were once close. PTSD was first recognized in male combat veterans. Today, however, the majority of people who have PTSD are young women who have experienced non combat-related trauma, such as sexual or physical assault or a life-threatening illness or accident. The disorder can be short-lived, but PTSD can also become chronic, with long lasting symptoms that are often treatment-resistant, possibly causing severe functional disability. Frequent trauma-related nightmares and other debilitating sleep disruptions are examples of chronic PTSD symptoms for which an effective treatment has not been developed. Sertraline and paroxetine, both selective serotonin reuptake inhibitors (SSRIs), are the only drugs approved by the FDA for treating PTSD. Neither of them, however, has been effective in reducing PTSD-related sleep disruption. Studies have shown that the drug prazosin has been effective in reducing distressing trauma-related nightmares in older male combat veterans. This study will evaluate the effectiveness of prazosin in treating post-traumatic stress disorder caused by noncombat trauma in individuals already being treated with SSRIs.

Participants in this double-blind study will first undergo 12 weeks of treatment with psychotherapy and a standard SSRI. After 12 weeks, participants will be randomly assigned to receive either prazosin or placebo in addition to psychotherapy and standard SSRI treatment for a total of 8 weeks. Study visits will occur weekly for the first 12 weeks, and then at Weeks 1, 2, 4, 6, and 8 during the 8-week phase. Additionally, follow-up visits will be held 4 and 18 weeks post-intervention. PTSD symptoms, disorder severity, and frequency of sleep disturbances will be assessed.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 20

Inclusion Criteria

Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of PTSD, as derived from the Clinician-Administered PTSD Scale (CAPS)
Stabilized on any necessary medications for at least 4 weeks prior to study entry
Score of greater than 4 on the CAPS Recurrent Distressing Dreams item (maximum score of 8)
Score of greater than 4 on the CAPS Difficulty Falling or Staying Asleep item (maximum score of 8)
Agrees to use an effective form of contraception throughout the study

Exclusion Criteria

Any acute or significant chronic medical illness
Any unstable medical condition
Unstable angina, recent heart attack, history of congestive heart failure, pre-existing hypotension (systolic blood pressure less than 110 mm Hg), or orthostatic hypotension
Insulin-dependent diabetes
Chronic kidney or liver failure
Pancreatitis or gout
Meniere's disease, benign positional vertigo, or narcolepsy
Allergy or previous adverse reaction to prazosin or other alpha-1 antagonist
Currently taking another alpha-1 antagonist agent
Pregnant
DSM-IV diagnosis of cognitive disorder, schizophrenia, schizoaffective disorder, bipolar disorder, or other psychotic disorder
Current delirium
Active substance dependence disorder within 3 months of study entry
Current substance use other than alcohol (no more than 2 drinks per day)
Severe psychiatric instability or situational life crises, including evidence of suicidal or homicidal ideation
Currently taking any other psychotropic medication (e.g., antidepressants, benzodiazepines, anti-convulsants, anti-psychotics, sedating antihistamines, sedatives/hypnotics (exclusionary medications will be discontinued and participants will undergo a 2-week washout period before baseline assessments)

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
2	Psychotherapy	Participants will receive treatment with placebo plus psychotherapy
1	Psychotherapy	Participants will receive treatment with prazosin plus psychotherapy
2	Placebo	Participants will receive treatment with placebo plus psychotherapy
1	Prazosin	Participants will receive treatment with prazosin plus psychotherapy

Primary Outcome Measures

Name	Time	Method
Clinical Global Impression of Change	Baseline to Week 8	The Clinical Global Impression of Change is a 7-point scale that rates global change compared to baseline (1=markedly improved, 2=moderately improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=moderately worse, 7=markedly worse). The Clinical Global Impression of Change is used to determine the impact of treatment effects on meaningful and distinct change in overall sense of well-being and functioning. This outcome measure evaluates change from Baseline to Week 8.
Change in Recurring Distressing Dreams and Difficulty Falling and Staying Asleep Items of the CAPS	Baseline to Week 8	Item B-2 "recurrent distressing dreams of the event" is a single item from teh Clinician Administered PTSD Scale (CAPS). The rating consists of two parts: Frequency plus Intensity. Symptom frequency rated 0 to 4. Symptom intensity rated 0 to 4. Frequency plus Intensity ratings equal the total score. The total minimum score = zero. The total maximum score = 8. A higher score is worse; a lower score is better. This outcome measure evaluates the change in score from Baseline to Week 8.
Change in Sleep Assessed by the Pittsburgh Sleep Quality Index	Baseline to Week 8	Pittsburgh Sleep Quality Index is a self-report questionnaire assessing sleep quality and disturbances over a 1-month time interval. A global score is obtained by summing the seven component subscales (total score range: 0-21). A score of 5 or less indicates good sleep quality. A score of more than 5 indicates poor sleep quality. Change is measured from Baseline to Week 8.